Causes of Geographic Divergence in American Mortality Between 1990 and 2015: Health Behaviors, Health Care Access and Migration

项目总结/摘要 2019年冠状病毒病（COVID-19）是一种国际突发公共卫生事件，由 呼吸道飞沫传播冠状病毒2型（SARS CoV-2）病毒。美国已 成为大流行病的中心，具有独特的区域模式。迄今为止，COVID- 19.死亡率在很大程度上是使用包含COVID参考的死亡证明进行监测的- 19.然而，先前对超额死亡率的分析表明，12%至25%的超额死亡 于二零二零年，并无直接归属于COVID-19。未被分配到COVID的死亡百分比- 19也被称为显着不同的状态和县级社会人口因素。 然而，在多大程度上超额死亡率和超额死亡率未分配， 对COVID-19的反应因地区和城乡而异。拟议补编 将在目前关于死亡率地域不平等问题的工作基础上， 重点关注COVID-19。我们对COVID-19相关的超额死亡率的初步工作 显示COVID-19的死亡率和非COVID-19的超额死亡率各不相同， 基本上跨越由其社会人口和健康定义的美国县的子集 特点和沿着城乡连续体。这一初步工作也提出了 关于各州和县死亡原因编码质量的问题。的 建议的补充将使我们能够扩大我们的分析，以超额死亡率和直接 按地理位置和种族/民族划分的COVID-19死亡率。有相当多的证据 超额死亡率和COVID-19死亡率因种族/民族而异，但很少有人知道 大流行对美国各种族/族裔亚组的影响因地理而异。我们将 还调查了死因编码差异对估计的潜在影响， 超额死亡率和直接归因于COVID-19的死亡率的地理不平等。关切 关于死亡原因编码的质量也提出了新的报告， 科学、工程和医学院， 工作年龄的成年人。

PROJECT SUMMARY/ABSTRACT Coronavirus disease-2019 (COVID-19) is an international public health emergency caused by the respiratory droplet transmission of the coronavirus-2 (SARS CoV-2) virus. The United States has emerged as an epicenter of the pandemic, with distinctive regional patterning. To date, COVID- 19 mortality has largely been monitored using death certificates that contain reference to COVID- 19. However, prior analyses of excess mortality reveal that between 12% to 25% of excess deaths in 2020 were not directly assigned to COVID-19. The percent of deaths not assigned to COVID- 19 is also known to vary significantly by state and by county-level sociodemographic factors. However, it remains unknown to what extent excess mortality and excess mortality not assigned to COVID-19 differs by region and across the urban-rural continuum. The proposed Supplement will build upon and expand on current work on geographic inequalities in mortality by integrating a focus on COVID-19. Our preliminary work on excess mortality associated with COVID-19 has shown that mortality from COVID-19 and excess mortality not assigned to COVID-19 varies substantially across subsets of U.S. counties defined by their sociodemographic and health characteristics and along the urban-rural continuum. This preliminary work has also raised questions about the quality of the coding of causes of death across states and counties. The proposed supplement will enable us to expand our analyses to excess mortality and directly assigned COVID-19 mortality by geography and race/ethnicity. There is considerable evidence that excess mortality and COVID-19 mortality varies by race/ethnicity but little is known how the impact of the pandemic on the various U.S. racial/ethnic subgroups varies by geography. We will also investigate the potential impact of cause of death coding differentials on estimates of geographic inequalities in excess mortality and mortality directly assigned to COVID-19. Concerns about the quality of cause-of-death coding were also raised by the new report of the National Academy of Sciences, Engineering and Medicine, High and Rising Mortality Rates among Working-age Adults.